Infant deaths costly, tragic

Sylvia Porter

The figures are tragic, embarrassing and unnecessary. The United States, with the most advanced and expensive health-care system in the world, ranks a deplorable 25th in infant deaths. The majority of these deaths are due to premature or low-weight births. Women under 18 or over 35, those who smoke, abuse alcohol or other drugs, or those with chronic illnesses or conditions such as diabetes and high blood pressure are at increased risk of delivering prematurely.

Aside from the human toll, the costs associated with caring for low-birth weight babies are staggering. Intensive-care nursery costs generally exceed $1,000 a day and can easily reach $250,000 for a single case. Premature or low-birth weight infants add about $2 billion a year to the U.S. health bill. Everyone who buys health insurance or pays taxes shares that bill.

Residents of Massachusetts recently got a clear look at just how expensive this type of care can be. In a study of the state's 50 costliest Medicaid cases for last year, the Massachusetts Department of Public Welfare found that half involved infants and toddlers. The expense was mainly for intensive care of premature infants and hospital treatment for birth defects.

To use the word "expense" greatly understates the situation. The Massachusetts cases involved medical bills in the $300,000 to $600,000 range. The highest was $655,000. Better prenatal care could have prevented untold anguish and saved millions of dollars in health-care costs.

When costs of this magnitude are applied to the health-insurance plan at your company, it's obvious that one or two low-birth weight infants a year can strain your employer's entire health-care budget. But there are ways to combat the problem. Prevention programs that emphasize comprehensive prenatal care are the best bet.

Complicated medical examinations and high-tech wonder machines are not needed. It's as simple as making sure every woman visits a doctor early in her pregnancy and then continues with prenatal care until delivery.

The state of Mississippi, which once had the nation's worst infant mortality statistics, is a prime example of how a strong prenatal program can turn things around. By providing regular prenatal care to scores of women who couldn't afford it, Mississippi has cut its infant death rate by more than half.

So has the state of Iowa, with a regional program launched at the University of Iowa hospitals by Dr. Herman Hein. It is the largest such program in the nation, yet operates with a budget of $500,000, less than the cost of one case in the Massachusetts study. Dr. Hein believes the problem begins with the lack of a national commitment to reproductive education.

Progress is being made in the private sector. For instance, early and effective prenatal care is the cornerstone of a program developed by Aetna Life & Casualty. Called Healthy Beginnings, the program was introduced in January 1990. It is a group health benefit designed to help employers reduce their escalating health benefits costs by reducing the number of premature births.

Healthy Beginnings uses a screening process to identify women who are at increased risk of early delivery. A nurse consultant makes sure each woman finds a qualified obstetrician and receives care early in the pregnancy. The nurse also provides support and counseling throughout the pregnancy via a toll-free telephone number. The program uses educational materials and information from the "Babies and You" program developed by the March of Dimes Birth Defects Foundation.

Medical experts say that better prenatal care could reduce the number of premature births by as much as 40,000 each year. This would translate into fewer infant deaths and strike a blow against escalating health costs. We know how to attack the problem. All that's needed is the commitment to follow through.